Patient Dies from Blood Clots due to Failure to Monitor Coumadin and INR Level

The following excerpt from a Notice of Intent to File Claim, or more commonly called "Notice of Intent to Sue," is a recent case that the litigators at Erlich, Rosen, Bartnick & Cook, P.C., have begun on behalf of one of our clients.  If you wish to discuss a medical malpractice claim please contact ERBC at either www.ERBClaw.com or 1-800-595-0506 for a free consultation.

Claimant’s decedent, age 85, was an inpatient at Defendant Hospital through their emergency department from 11-29-07 to 12-7-07 with a chief complaint of weakness. Defendant internist was her hospital assigned attending physician throughout this hospitalization. The Plaintiff had a history of atrial fibrillation for which she was taking Coumadin on a daily basis to prevent clotting.  Her INR upon admission was elevated at 3.9 and Defendant internist discontinued her Coumadin.  There was concern of rectal bleeding and a colonoscopy was performed. A small isolated ulcer was found near her rectum which was biopsied. The remainder of the colonoscopy was unremarkable.

By the time of discharge on 12-7-07 Plaintiff was feeling much better and her INR had fallen to below therapeutic range to 1.9.  Defendant internist discharged Plaintiff without reinitiating her Coumadin therapy.  Plaintiff returned to her assisted living at Defendant Nursing Home where she was under the care of a primary care physician who also failed to reinstate her Coumadin regimen and did not order any blood work to determine her INR levels. Nine days went by without any blood thinners being prescribed or administered to Plaintiff and she developed severe pain and numbness in both of her lower extremities. The primary care physician ordered her to be taken by ambulance back to Defendant Hospital where she returned to the emergency department and was seen by Defendant Emergency Medicine physician.

The Emergency Medicine physicians’ dictated report indicates as follows: "This is an 85 year old female.  The only thing we can get is that she was sent to the department because she was hurting. She has chronic leg pain from spinal stenosis. She got Vicodin earlier this evening, but it did not seem to help. She cried and complained all night. We were unable to ascertain any other reason for the patient’s visit. She herself states that nothing else is wrong. The pain is chronic, but she just cannot get a hold of it tonight. She does describe the pain as 10 out of 10... There is slight decreased sensation in the lower extremities. There is downgoing Babinski but no other reflexes. It is unclear whether this is chronic or new."

The Defendant ER doctor misdiagnosed Plaintiff’s 10 out of 10 bilateral leg pain as emanating from a spinal stenosis condition. Despite all the signs and symptoms of a clotting condition, and access to the earlier INR levels and records from the admission nine days earlier, Defendant ER doctor did not order any blood work to determine Plaintiff’s INR level nor did she perform any pedal pulse testing or order a Doppler to determine venous sufficiency in Plaintiff’s lower extremities.  Instead she just drugged Plaintiff.

Defendant ER doctor’s dictated report indicates: "The patient received 75 mcg of fentanyl.  She did not get any relief. She was given Dilaudid twice and got good relief."  Between the Vicodin, fentanyl and double dose of dilaudid Plaintiff was finally knocked out and the ER physicians dictation goes on to state that not surprisingly, "she has been resting comfortably at this point for about one hour, so we are going to go ahead and send her back to the nursing facility to follow up. We do recommend increasing her medications so that she gets better relief for this chronic problem. The patient was released in good condition." 

In better words there was no attempt to diagnose the cause of Plaintiff’s bilateral numbness and 10 out of 10 pain by Defendant ER doctor but rather she was simply given enough narcotics to mask her symptoms and sent back to Defendant Nursing Home with the recommendation to increase her pain meds.

Plaintiff returned to Defendant Nursing Home under the care of Defendant primary care physician and the nursing staff at 1:00 P.M. on 12-16-07.  The progress notes indicate that Plaintiff was still complaining of bilateral lower extremity pain and she was given pain medications per Defendant primary care physician’s orders. At 11:45 A.M. on 12-18-07 it was noted that Plaintiff’s lower extremities were numb and cool to the touch and turning a deep purple. A wound care nurse came in to see her and contacted Defendant primary care physician who ordered her transferred by ambulance to the hospital.

This time Plaintiff was taken to a competent hospital where she was immediately diagnosed with bilateral severe clotting in her legs due to her INR being well below therapeutic level at 1.36.  Emergency surgery was performed by a vascular surgeon who removed massive clots from both legs and was able to restore blood flow. Unfortunately, Plaintiff’s condition had been allowed to progress to the point where she suffered tissue death and the release of toxins into her body. Plaintiff suffered multi organ failure and died on 12-19-07 as a direct and proximate result of the bilateral severe clotting from her uncontrolled INR level. This was directly caused by the failure of her treating physicians to reinstate her Coumadin therapy, monitor her INR levels, and failure to diagnose the clotting condition in a timely manner.